1. Death by Medicine
Gary Null PhD, Carolyn Dean MD ND, Martin Feldman MD
Debora Rasio MD, Dorothy Smith PhD
October 2003
Note: The information on this website is not a substitute for
diagnosis and treatment by a qualified, licensed professional.
(This article is posted with the permission of Nutrition Institute of America, Inc. (NIA, Inc.)
INDEX
 ABSTRACT
 TABLES AND FIGURES (See Section on Statistical Tables and Figures for
exposition)
 ANNUAL PHYSICAL AND ECONOMIC COST OF MEDICAL INTERVENTION
 ANNUAL UNNECESSARY MEDICAL EVENTS STATISTICS
 TEN-YEAR DEATH RATES FOR MEDICAL INTERVENTION
 TEN-YEAR STATISTICS FOR UNNECESSARY INTERVENTION
 INTRODUCTION
o Is American Medicine Working?
o Under-reporting of Iatrogenic Events
o Correcting a Compromised System
o Medical Ethics and Conflict of Interest in Scientific Medicine
 THE FIRST IATROGENIC STUDY
 ONLY A FRACTION OF MEDICAL ERRORS ARE REPORTED
 PUBLIC SUGGESTIONS ON IATROGENESIS
 DRUG IATROGENESIS
o Medication Errors
o Recent Adverse Drug Reactions
o Medicating Our Feelings
o Television Diagnosis

2. o How Do We Know Drugs Are Safe?
o Specific Drug Iatrogenesis: Antibiotics
o The Problem with Antibiotics: They are Anti-Life
o Drugs Pollute Our Water Supply
o Specific Drug Iatrogenesis: NSAIDs
o Specific Drug Iatrogenesis: Cancer Chemotherapy
o Drug Companies Fined
 UNNECESSARY SURGICAL PROCEDURES
 MEDICAL AND SURGICAL PROCEDURES
 WHY AREN'T MEDICAL AND SURGICAL PROCEDURES STUDIED?
 SURGICAL ERRORS FINALLY REPORTED
 UNNECESSARY X-RAYS
 UNNECESSARY HOSPITALIZATION
 WOMEN'S EXPERIENCE IN MEDICINE
o Cesarean Section
 NEVER ENOUGH STUDIES
 OVERVIEW OF STATISTICAL TABLES AND FIGURES
o Adverse Drug Reaction
o Bedsores
o Malnutrition in Nursing Homes
o Nosocomial Infections
o Outpatient Iatrogenesis
o Unnecessary Surgeries
 IT'S A GLOBAL ISSUE
 HEALTH INSURANCE
o Insurance Fraud
 WAREHOUSING OUR ELDERS
o Important Statistics about Nursing Homes
o Over-medicating Seniors
 WHAT REMAINS TO BE UNCOVERED
 CONCLUSION
 REFERENCES

3. ABSTRACT
A definitive review and close reading of medical peer-review journals, and
government health statistics shows that American medicine frequently causes more
harm than good. The number of people having in-hospital, adverse drug reactions
(ADR) to prescribed medicine is 2.2 million.1 Dr. Richard Besser, of the CDC, in
1995, said the number of unnecessary antibiotics prescribed annually for viral
infections was 20 million. Dr. Besser, in 2003, now refers to tens of millions of
unnecessary antibiotics.2, 2a The number of unnecessary medical and surgical
procedures performed annually is 7.5 million.3 The number of people exposed to
unnecessary hospitalization annually is 8.9 million.4 The total number of iatrogenic
deaths shown in the following table is 783,936. It is evident that the American
medical system is the leading cause of death and injury in the United States. The
2001 heart disease annual death rate is 699,697; the annual cancer death rate,
553,251.5
TABLES AND FIGURES (see Section on Statistical Tables and Figures, below, for
exposition)
ANNUAL PHYSICAL AND ECONOMIC COST OF MEDICAL INTERVENTION
Condition Deaths Cost Author
Hospital ADR 106,000 $12 billion Lazarou1 Suh49
Medical error 98,000 $2 billion IOM6
Bedsores 115,000 $55 billion Xakellis7 Barczak8
Infection 88,000 $5 billion Weinstein9 MMWR10
Malnutrition 108,800 -------- Nurses Coalition11
Outpatient ADR 199,000 $77 billion Starfield12 Weingart112
Unnecessary
Procedures
37,136 $122 billion HCUP3,13
Surgery-Related 32,000 $9 billion AHRQ85
TOTAL 783,936 $282 billion

4. We could have an even higher death rate by using Dr. Lucien Leape’s 1997 medical
and drug error rate of 3 million. 14 Multiplied by the fatality rate of 14% (that Leape
used in 199416 we arrive at an annual death rate of 420,000 for drug errors and
medical errors combined. If we put this number in place of Lazorou’s 106,000 drug
errors and the Institute of Medicine’s (IOM) 98,000 medical errors, we could add
another 216,000 deaths making a total of 999,936 deaths annually.
Condition Deaths Cost Author
ADR/med
error
420,000 $200 billion Leape 199714
TOTAL 999,936
ANNUAL UNNECESSARY MEDICAL EVENTS STATISTICS
Unnecessary Events People Affected Iatrogenic Events
Hospitalization 8.9 million4 1.78 million16
Procedures
7.5 million3
1.3 million40
TOTAL 16.4 million 3.08 million
The enumerating of unnecessary medical events is very important in our analysis.
Any medical procedure that is invasive and not necessary must be considered as
part of the larger iatrogenic picture. Unfortunately, cause and effect go unmonitored.
The figures on unnecessary events represent people (“patients”) who are thrust into a
dangerous healthcare system. They are helpless victims. Each one of these 16.4
million lives is being affected in a way that could have a fatal consequence. Simply
entering a hospital could result in the following:
1. In 16.4 million people, 2.1% chance of a serious adverse drug reaction,1
(186,000)
2. In 16.4 million people, 5-6% chance of acquiring a nosocomial infection,9
(489,500)

5. 3. In16.4 million people, 4-36% chance of having an iatrogenic injury in hospital
(medical error and adverse drug reactions),16 (1.78 million)
4. In 16.4 million people, 17% chance of a procedure error,40 (1.3 million)
All the statistics above represent a one-year time span. Imagine the numbers over a
ten-year period. Working with the most conservative figures from our statistics we
project the following 10-year death rates.
TEN-YEAR DEATH RATES FOR MEDICAL INTERVENTION
Condition 10-Year Deaths Author
Adverse Drug Reaction 1.06 million
(1)
Medical error
0.98 million
(6)
Bedsores 1.15 million (7,8)
Nosocomial Infection 0.88 million (9,10)
Malnutrition 1.09 million (11)
Outpatients
1.99 million
(12, 112)
Unnecessary
Procedures
371,360 (3,13)
Surgery-related 320,000 (85)
TOTAL
7,841,360 (7.8
million)
Our projected statistic of 7.8 million iatrogenic deaths is more than all the casualties
from wars that America has fought in its entire history.
Our projected figures for unnecessary medical events occurring over a 10-year
period are also dramatic.

6. TEN-YEAR STATISTICS FOR UNNECESSARY INTERVENTION
Unnecessary Events 10-year Number Iatrogenic
Events
Hospitalization
89 million4
17 million
Procedures 75 million3 15 million
TOTAL 164 million
These projected figures show that a total of 164 million people, approximately 56% of
the population of the United States, have been treated unnecessarily by the medical
industry – in other words, nearly 50,000 people per day.
We have added, cumulatively, figures from 13 references of annual iatrogenic
deaths. However, there is invariably some degree of overlap and double counting
that can occur in gathering non-finite statistics. Death numbers don’t come with
names and birth dates to prevent duplication On the other hand, there are many
missing statistics. As we will show, only about 5 to 20% of iatrogenic incidents are
even recorded.16,24,25,33,34 And, our outpatient iatrogenic statistics112 only include
drug-related events and not surgical cases, diagnostic errors, or therapeutic mishaps.
We have also been conservative in our inclusion of statistics that were not reported in
peer review journals or by government institutions. For example, on July 23, 2002,
The Chicago Tribune analyzed records from patient databases, court cases, 5,810
hospitals, as well as 75 federal and state agencies and found 103,000 cases of death
due to hospital infections, 75% of which were preventable.152 We do not include this
figure but report the lower Weinstein figure of 88,000.9 Another figure that we
withheld, for lack of proper peer review was The National Committee for Quality
Assurance, September 2003 report which found that at least 57,000 people die
annually from lack of proper care for commons diseases such as high blood
pressure, diabetes, or heart disease.153
Overlapping of statistics in Death by Medicine may occur with the Institute of
Medicine (IOM) paper that designates "medical error" as including drugs, surgery,
and unnecessary procedures.6 Since we have also included other statistics on

7. adverse drug reactions, surgery and, unnecessary procedures, perhaps a much as
50% of the IOM number could be redundant. However, even taking away half the
98,000 IOM number still leaves us with iatrogenic events as the number one killer at
738,000 annual deaths.
INTRODUCTION
Never before have the complete statistics on the multiple causes of iatrogenesis
been combined in one paper. Medical science amasses tens of thousands of papers
annually - each one a tiny fragment of the whole picture. To look at only one piece
and try to understand the benefits and risks is to stand one inch away from an
elephant and describe everything about it. You have to pull back to reveal the
complete picture, such as we have done here. Each specialty, each division of
medicine, keeps their own records and data on morbidity and mortality like pieces of
a puzzle. But the numbers and statistics were always hiding in plain sight. We have
now completed the painstaking work of reviewing thousands and thousands of
studies. Finally putting the puzzle together we came up with some disturbing
answers.
Is American Medicine Working?
At 14% of the Gross National Product, healthcare spending reached $1.6 trillion in
2003.15 Considering this enormous expenditure, we should have the best medicine in
the world. We should be reversing disease, preventing disease, and doing minimal
harm. However, careful and objective review shows the opposite. Because of the
extraordinary narrow context of medical technology through which contemporary
medicine examines the human condition, we are completely missing the full picture.
Medicine is not taking into consideration the following monumentally important
aspects of a healthy human organism: (a) stress and how it adversely affects the
immune system and life processes; (b) insufficient exercise; (c) excessive caloric
intake; (d) highly-processed and denatured foods grown in denatured and
chemically-damaged soil; and (e) exposure to tens of thousands of environmental
toxins. Instead of minimizing these disease-causing factors, we actually cause more
illness through medical technology, diagnostic testing, overuse of medical and
surgical procedures, and overuse of pharmaceutical drugs. The huge disservice of

8. this therapeutic strategy is the result of little effort or money being appropriated for
preventing disease.
Under-reporting of Iatrogenic Events
As few as 5% and only up to 20% of iatrogenic acts are ever reported.16,24,25,33,34 This
implies that if medical errors were completely and accurately reported, we would
have a much higher annual iatrogenic death rate than 783,936. Dr. Leape, in 1994,
said his figure of 180,000 medical mistakes annually was equivalent to three jumbo-
jet crashes every two days.16 Our report shows that 6 jumbo jets are falling out of the
sky each and every day.
Correcting a Compromised System
What we must deduce from this report is that medicine is in need of complete and
total reform: from the curriculum in medical schools to protecting patients from
excessive medical intervention. It is quite obvious that we can’t change anything if we
are not honest about what needs to be changed. This report simply shows the
degree to which change is required. We are fully aware that what stands in the way
of change are powerful pharmaceutical companies, medical technology companies,
and special interest groups with enormous vested interests in the business of
medicine. They fund medical research, support medical schools and hospitals, and
advertise in medical journals. With deep pockets they entice scientists and
academics to support their efforts. Such funding can sway the balance of opinion
from professional caution to uncritical acceptance of a new therapy or drug. You only
have to look at the number of invested people on hospital, medical, and government
health advisory boards to see conflict of interest. The public is mostly unaware of
these interlocking interests. For example, a 2003 study found that nearly half of
medical school faculty, who serve on Institutional Review Boards (IRB) to advise on
clinical trial research, also serve as consultants to the pharmaceutical industry.17 The
authors were concerned that such representation could cause potential conflicts of
interest. A news release by Dr. Erik Campbell, the lead author, said, "Our previous
research with faculty has shown us that ties to industry can affect scientific behavior,
leading to such things as trade secrecy and delays in publishing research. It's

9. possible that similar relationships with companies could affect IRB members'
activities and attitudes.”18
Medical Ethics and Conflict of Interest in Scientific Medicine
Jonathan Quick, Director of Essential Drugs and Medicines Policy for the World
Health Organization wrote in a recent WHO Bulletin: "If clinical trials become a
commercial venture in which self-interest overrules public interest and desire
overrules science, then the social contract which allows research on human subjects
in return for medical advances is broken."19
Former editor of the New England Journal of Medicine (NEJM), Dr. Marcia Angell,
struggled to bring the attention of the world to the problem of commercializing
scientific research in her outgoing editorial titled “Is Academic Medicine for Sale?”20
Angell called for stronger restrictions on pharmaceutical stock ownership and other
financial incentives for researchers. She said that growing conflicts of interest are
tainting science. She warned that, “When the boundaries between industry and
academic medicine become as blurred as they are now, the business goals of
industry influence the mission of medical schools in multiple ways.” She did not
discount the benefits of research but said a Faustian bargain now existed between
medical schools and the pharmaceutical industry.
Angell left the NEMJ in June, 2000. Two years later, in June, 2002, the NEJM
announced that it will now accept biased journalists (those who accept money from
drug companies) because it is too difficult to find ones that have no ties. Another
former editor of the journal, Dr. Jerome Kassirer, said that was just not the case, that
there are plenty of researchers who don’t work for drug companies.21 The ABC report
said that one measurable tie between pharmaceutical companies and doctors
amounts to over $2 billion a year spent for over 314,000 events that doctors attend.
The ABC report also noted that a survey of clinical trials revealed that when a drug
company funds a study, there is a 90% chance that the drug will be perceived as
effective whereas a non-drug company-funded study will show favorable results 50%
of the time. It appears that money can’t buy you love but it can buy you any
"scientific" result you want. The only safeguard to reporting these studies was if the
journal writers remained unbiased. That is no longer the case.

10. Cynthia Crossen, writer for the Wall Street Journal in 1996, published Tainted Truth:
The Manipulation of Fact in America, a book about the widespread practice of lying
with statistics.22 Commenting on the state of scientific research she said that, “The
road to hell was paved with the flood of corporate research dollars that eagerly filled
gaps left by slashed government research funding.” Her data on financial involvement
showed that in l981 the drug industry “gave” $292 million to colleges and universities
for research. In l991 it “gave” $2.1 billion.
THE FIRST IATROGENIC STUDY
Dr. Lucian L. Leape opened medicine’s Pandora’s box in his 1994 JAMA paper,
“Error in Medicine”.16 He began the paper by reminiscing about Florence
Nightingale’s maxim – “first do no harm.” But he found evidence of the opposite
happening in medicine. He found that Schimmel reported in 1964 that 20% of
hospital patients suffered iatrogenic injury, with a 20% fatality rate. Steel in 1981
reported that 36% of hospitalized patients experienced iatrogenesis with a 25%
fatality rate and adverse drug reactions were involved in 50% of the injuries. Bedell in
1991 reported that 64% of acute heart attacks in one hospital were preventable and
were mostly due to adverse drug reactions. However, Leape focused on his and
Brennan’s “Harvard Medical Practice Study” published in 1991.16a They found that in
1984, in New York State, there was a 4% iatrogenic injury rate for patients with a
14% fatality rate. From the 98,609 patients injured and the 14% fatality rate, he
estimated that in the whole of the U.S. 180,000 people die each year, partly as a
result of iatrogenic injury. Leape compared these deaths to the equivalent of three
jumbo-jet crashes every two days.
Why Leape chose to use the much lower figure of 4% injury for his analysis remains
in question. Perhaps he wanted to tread lightly. If Leape had, instead, calculated the
average rate among the three studies he cites (36%, 20%, and 4%), he would have
come up with a 20% medical error rate. The number of fatalities that he could have
presented, using an average rate of injury and his 14% fatality, is an annual
1,189,576 iatrogenic deaths, or over ten jumbo jets crashing every day
Leape acknowledged that the literature on medical error is sparse and we are only
seeing the tip of the iceberg. He said that when errors are specifically sought out,

11. reported rates are “distressingly high”. He cited several autopsy studies with rates as
high as 35-40% of missed diagnoses causing death. He also commented that an
intensive care unit reported an average of 1.7 errors per day per patient, and 29% of
those errors were potentially serious or fatal. We wonder: what is the effect on
someone who daily gets the wrong medication, the wrong dose, the wrong
procedure; how do we measure the accumulated burden of injury; and when the
patient finally succumbs after the tenth error that week, what is entered on the death
certificate?
Leape calculated the rate of error in the intensive care unit. First, he found that each
patient had an average of 178 “activities” (staff/procedure/medical interactions) a day,
of which 1.7 were errors, which means a 1% failure rate. To some this may not seem
like much, but putting this into perspective, Leape cited industry standards where in
aviation a 0.1% failure rate would mean 2 unsafe plane landings per day at O’Hare
airport; in the U.S. Mail, 16,000 pieces of lost mail every hour; or in banking, 32,000
bank checks deducted from the wrong bank account every hour.
Analyzing why there is so much medical error Leape acknowledged the lack of
reporting. Unlike a jumbo-jet crash, which gets instant media coverage, hospital
errors are spread out over the country in thousands of different locations. They are
also perceived as isolated and unusual events. However, the most important reason
that medical error is unrecognized and growing, according to Leape, was, and still is,
that doctors and nurses are unequipped to deal with human error, due to the culture
of medical training and practice. Doctors are taught that mistakes are unacceptable.
Medical mistakes are therefore viewed as a failure of character and any error equals
negligence. We can see how a great deal of sweeping under the rug takes place
since nobody is taught what to do when medical error does occur. Leape cited
McIntyre and Popper who said the “infallibility model” of medicine leads to intellectual
dishonesty with a need to cover up mistakes rather than admit them. There are no
Grand Rounds on medical errors, no sharing of failures among doctors and no one to
support them emotionally when their error harms a patient.
Leape hoped his paper would encourage medicine “to fundamentally change the way
they think about errors and why they occur”. It’s been almost a decade since this
groundbreaking work, but the mistakes continue to soar.

12. One year later, in 1995, a report in JAMA said that, "Over a million patients are
injured in U.S. hospitals each year, and approximately 280,000 die annually as a
result of these injuries. Therefore, the iatrogenic death rate dwarfs the annual
automobile accident mortality rate of 45,000 and accounts for more deaths than all
other accidents combined."23
At a press conference in 1997 Dr. Leape released a nationwide poll on patient
iatrogenesis conducted by the National Patient Safety Foundation (NPSF), which is
sponsored by the American Medical Association. The survey found that more than
100 million Americans have been impacted directly and indirectly by a medical
mistake. Forty-two percent were directly affected and a total of 84% personally knew
of someone who had experienced a medical mistake.14 Dr. Leape is a founding
member of the NPSF.
Dr. Leape at this press conference also updated his 1994 statistics saying that
medical errors in inpatient hospital settings nationwide, as of 1997, could be as high
as three million and could cost as much as $200 billion. Leape used a 14% fatality
rate to determine a medical error death rate of 180,000 in 1994.16 In 1997, using
Leape’s base number of three million errors, the annual deaths could be as much as
420,000 for inpatients alone. This does not include nursing home deaths, or people in
the outpatient community dying of drug side effects or as the result of medical
procedures.
ONLY A FRACTION OF MEDICAL ERRORS ARE REPORTED
Leape, in 1994, said that he was well aware that medical errors were not being
reported.16 According to a study in two obstetrical units in the U.K., only about one
quarter of the adverse incidents on the units are ever reported for reasons of
protecting staff or preserving reputations, or fear of reprisals, including law suits.24 An
analysis by Wald and Shojania found that only 1.5% of all adverse events result in an
incident report, and only 6% of adverse drug events are identified properly. The
authors learned that the American College of Surgeons gives a very broad guess that
surgical incident reports routinely capture only 5-30% of adverse events. In one
surgical study only 20% of surgical complications resulted in discussion at Morbidity
and Mortality Rounds.25 From these studies it appears that all the statistics that are

13. gathered may be substantially underestimating the number of adverse drug and
medical therapy incidents. It also underscores the fact that our mortality statistics are
actually conservative figures.
An article in Psychiatric Times outlines the stakes involved with reporting medical
errors.26 They found that the public is fearful of suffering a fatal medical error, and
doctors are afraid they will be sued if they report an error. This brings up the obvious
question: who is reporting medical errors? Usually it is the patient or the patient’s
surviving family. If no one notices the error, it is never reported. Janet Heinrich, an
associate director at the U.S. General Accounting Office responsible for health
financing and public health issues, testifying before a House subcommittee about
medical errors, said that, "The full magnitude of their threat to the American public is
unknown.” She added, "Gathering valid and useful information about adverse events
is extremely difficult." She acknowledged that the fear of being blamed, and the
potential for legal liability, played key roles in the under-reporting of errors. The
Psychiatric Times noted that the American Medical Association is strongly opposed
to mandatory reporting of medical errors.26 If doctors aren’t reporting, what about
nurses? In a survey of nurses, they also did not report medical mistakes for fear of
retaliation.27
Standard medical pharmacology texts admit that relatively few doctors ever report
adverse drug reactions to the FDA.28 The reasons range from not knowing such a
reporting system exists to fear of being sued because they prescribed a drug that
caused harm. 29 However, it is this tremendously flawed system of voluntary reporting
from doctors that we depend on to know whether a drug or a medical intervention is
harmful.
Pharmacology texts will also tell doctors how hard it is to separate drug side effects
from disease symptoms. Treatment failure is most often attributed to the disease and
not the drug or the doctor. Doctors are warned, “Probably nowhere else in
professional life are mistakes so easily hidden, even from ourselves.”30 It may be
hard to accept, but not difficult to understand, why only one in twenty side effects is
reported to either hospital administrators or the FDA.31,31

14. If hospitals admitted to the actual number of errors and mistakes, which is about 20
times what is reported, they would come under intense scrutiny.32 Jerry Phillips,
associate director of the Office of Post Marketing Drug Risk Assessment at the FDA,
confirms this number. “In the broader area of adverse drug reaction data, the 250,000
reports received annually probably represent only 5% of the actual reactions that
occur.”33 Dr. Jay Cohen, who has extensively researched adverse drug reactions,
comments that because only 5% of adverse drug reactions are being reported, there
are, in reality, five million medication reactions each year.34
It remains that whatever figure you choose to believe about the side effects from
drugs, all the experts agree that you have to multiply that by 20 to get a more
accurate estimate of what is really occurring in the burgeoning “field” of iatrogenic
medicine.
A 2003 survey is all the more distressing because there seems to be no improvement
in error-reporting even with all the attention on this topic. Dr. Dorothea Wild surveyed
medical residents at a community hospital in Connecticut. She found that only half of
the residents were aware that the hospital had a medical error-reporting system, and
the vast majority didn’t use it at all. Dr. Wild says this does not bode well for the
future. If doctors don’t learn error-reporting in their training, they will never use it. And
she adds that error reporting is the first step in finding out where the gaps in the
medical system are and fixing them. That first baby step has not even begun.35
PUBLIC SUGGESTIONS ON IATROGENESIS
In a telephone survey, 1,207 adults were asked to indicate how effective they thought
the following would be in reducing preventable medical errors that resulted in serious
harm:36
 giving doctors more time to spend with patients: very effective 78%
 requiring hospitals to develop systems to avoid medical errors: very effective
74%
 better training of health professionals: very effective 73%
 using only doctors specially trained in intensive care medicine on intensive
care units: very effective 73%

15.  requiring hospitals to report all serious medical errors to a state agency: very
effective 71%
 increasing the number of hospital nurses: very effective 69%
 reducing the work hours of doctors-in-training to avoid fatigue: very effective
66%
 encouraging hospitals to voluntarily report serious medical errors to a state
agency: very effective 62%
DRUG IATROGENESIS
Drugs comprise the major treatment modality of scientific medicine. With the
discovery of the “Germ Theory” medical scientists convinced the public that infectious
organisms were the cause of illness. Finding the “cure” for these infections proved
much harder than anyone imagined. From the beginning, chemical drugs promised
much more than they delivered. But far beyond not working, the drugs also caused
incalculable side effects. The drugs themselves, even when properly prescribed,
have side effects that can be fatal, as Lazarou’s study1 shows. But human error can
make the situation even worse.
Medication Errors
A survey of a 1992 national pharmacy database found a total of 429,827 medication
errors from 1,081 hospitals. Medication errors occurred in 5.22% of patients admitted
to these hospitals each year. The authors concluded that a minimum of 90,895
patients annually were harmed by medication errors in the country as a whole.37
A 2002 study shows that 20% of hospital medications for patients had dosage
mistakes. Nearly 40% of these errors were considered potentially harmful to the
patient. In a typical 300-patient hospital the number of errors per day were 40.38
Problems involving patients’ medications were even higher the following year. The
error rate intercepted by pharmacists in this study was 24%, making the potential
minimum number of patients harmed by prescription drugs 417,908.39

16. Recent Adverse Drug Reactions
More recent studies on adverse drug reactions show that the figures from 1994
(published in Lazarou’s 1998 JAMA article) may be increasing. A 2003 study followed
four hundred patients after discharge from a tertiary care hospital (hospital care that
requires highly specialized skills, technology, or support services). Seventy-six
patients (19%) had adverse events. Adverse drug events were the most common at
66%. The next most common events were procedure-related injuries at 17%.40
In a NEJM study an alarming one-in-four patients suffered observable side effects
from the more than 3.34 billion prescription drugs filled in 2002.41 One of the doctors
who produced the study was interviewed by Reuters and commented that, "With
these 10-minute appointments, it's hard for the doctor to get into whether the
symptoms are bothering the patients."42 William Tierney, who editorialized on the
NEJM study, said “… given the increasing number of powerful drugs available to care
for the aging population, the problem will only get worse.” The drugs with the worst
record of side effects were the SSRIs, the NSAIDs, and calcium-channel blockers.
Reuters also reported that prior research has suggested that nearly 5% of hospital
admissions - over 1 million per year - are the result of drug side effects. But most of
the cases are not documented as such. The study found one of the reasons for this
failure: in nearly two-thirds of the cases, doctors couldn’t diagnose drug side effects
or the side effects persisted because the doctor failed to heed the warning signs.
Medicating Our Feelings
We only need to look at the side effects of antidepressant drugs, which give hope to
a depressed population. Patients seeking a more joyful existence and relief from
worry, stress, and anxiety, fall victim to the messages blatantly displayed on TV and
billboards. Often, instead of relief, they also fall victim to a myriad of iatrogenic side
effects of antidepressant medication.
Also, a whole generation of antidepressant users has resulted from young people
growing up on Ritalin. Medicating youth and modifying their emotions must have
some impact on how they learn to deal with their feelings. They learn to equate
coping with drugs and not their inner resources. As adults, these medicated youth
reach for alcohol, drugs, or even street drugs, to cope. According to the Journal of

17. the American Medical Association, “Ritalin acts much like cocaine.”43 Today’s
marketing of mood-modifying drugs, such as Prozac or Zoloft, makes them not only
socially acceptable but almost a necessity in today’s stressful world.
Television Diagnosis
In order to reach the widest audience possible, drug companies are no longer just
targeting medical doctors with their message about antidepressants. By 1995 drug
companies had tripled the amount of money allotted to direct advertising of
prescription drugs to consumers. The majority of the money is spent on seductive
television ads. From 1996 to 2000, spending rose from $791 million to nearly $2.5
billion.44 Even though $2.5 billion may seem like a lot of money, the authors comment
that it only represents 15% of the total pharmaceutical advertising budget. According
to medical experts “there is no solid evidence on the appropriateness of prescribing
that results from consumers requesting an advertised drug.” However, the drug
companies maintain that direct-to-consumer advertising is educational. Dr. Sidney M.
Wolfe, of the Public Citizen Health Research Group in Washington, D.C., argues that
the public is often misinformed about these ads.45 People want what they see on
television and are told to go to their doctor for a prescription. Doctors in private
practice either acquiesce to their patients’ demands for these drugs or spend
valuable clinic time trying to talk patients out of unnecessary drugs. Dr. Wolfe
remarks that one important study found that people mistakenly believe that the “FDA
reviews all ads before they are released and allows only the safest and most effective
drugs to be promoted directly to the public.”46
How Do We Know Drugs Are Safe?
Another aspect of scientific medicine that the public takes for granted is the testing of
new drugs. Unlike the class of people that take drugs who are ill and need
medication, in general, drugs are tested on individuals who are fairly healthy and not
on other medications that can interfere with findings. But when they are declared
“safe” and enter the drug prescription books, they are naturally going to be used by
people on a variety of other medications and who also have a lot of other health
problems. Then, a new Phase of drug testing called Post-Approval comes into play,
which is the documentation of side effects once drugs hit the market. In one very

18. telling report, the General Accounting Office (an agency of the U.S. Government)
"found that of the 198 drugs approved by the FDA between 1976 and 1985... 102 (or
51.5%) had serious post-approval risks... the serious post-approval risks (included)
heart failure, myocardial infarction, anaphylaxis, respiratory depression and arrest,
seizures, kidney and liver failure, severe blood disorders, birth defects and fetal
toxicity, and blindness."47
The investigative show NBC’s “Dateline” wondered if your doctor is moonlighting as a
drug rep. After a year-long investigation they reported that because doctors can
legally prescribe any drug to any patient for any condition, drug companies heavily
promote "off-label" and frequently inappropriate and non-tested uses of these
medications in spite of the fact that these drugs are only approved for specific
indications they have been tested for.48
The leading causes of adverse drug reactions are antibiotics (17%), cardiovascular
drugs (17%), chemotherapy (15%), and analgesics and anti-inflammatory agents
(15%).49
Specific Drug Iatrogenesis: Antibiotics
Dr. Egger, in a recent editorial, wrote that after fifty years of increasing use of
antibiotics, 30 million pounds of antibiotics are used in America per year.50Twenty-
five million pounds of this total are used in animal husbandry. The vast majority of
this amount, twenty-three million pounds, is used to try to prevent disease, the stress
of shipping, and to promote growth. Only 2 million pounds are given for specific
animal infections. Dr. Egger reminds us that low concentrations of antibiotics are
measurable in many of our foods, rivers, and streams around the world. Much of this
is seeping into bodies of water from animal farms.
Egger says overuse of antibiotics results in food-borne infections resistant to
antibiotics. Salmonella is found in 20% of ground meat but constant exposure of
cattle to antibiotics has made 84% of salmonella resistant to at least one anti-
salmonella antibiotic. Diseased animal food accounts for 80% of salmonellosis in
humans, or 1.4 million cases per year. The conventional approach to dealing with this
epidemic is to radiate food to try to kill all organisms but keep using the antibiotics
that cause the original problem. Approximately 20% of chickens are contaminated

19. with Campylobacter jejuni causing 2.4 million human cases of illness annually. Fifty-
four percent of these organisms are resistant to at least one anti-campylobacter
antimicrobial.
A ban on growth-promoting antibiotics in Denmark began in 1999, which led to a
decrease from 453,200 pounds to 195,800 pounds within a year. Another report from
Scandinavia found that taking away antibiotic growth promoters had no or minimal
effect on food production costs. Egger further warns that in America the current
crowded, unsanitary methods of animal farming support constant stress and
infection, and are geared toward high antibiotic use. He says these conditions would
have to be changed along with cutting back on antibiotic use.
In America, over 3 million pounds of antibiotics are used every year on humans. With
a population of 284 million Americans, this amount is enough to give every man,
woman and child 10 teaspoons of pure antibiotics per year. Egger says that exposure
to a steady stream of antibiotics has altered pathogens such as Streptococcus
pneumoniae, Staplococcus aureus, and entercocci, to name a few.
Almost half of patients with upper respiratory tract infections in the U.S. still receive
antibiotics from their doctor.51 According to the CDC, 90% of upper respiratory
infections are viral and should not be treated with antibiotics. In Germany the
prevalence for systemic antibiotic use in children aged 0-6 years was 42.9%.52
Data taken from nine U.S. health plans between 1996-2000 on antibiotic use in
25,000 children found that rates of antibiotic use decreased. Antibiotic use in
children, aged 3 months to under 3 years, decreased 24%, from 2.46 to 1.89
antibiotic prescriptions per/patient per/year. For children, 3 years to under 6 years,
there was a 25% reduction from 1.47 to 1.09 antibiotic prescriptions per/patient
per/year. And for children aged 6 to under 18 years, there was a 16% reduction from
0.85 to 0.69 antibiotic prescriptions per/ patient /per year.53 Although there was a
reduction in antibiotic use, the data indicate that on average every child in America
receives 1.22 antibiotic prescriptions annually.
Group A beta-hemolytic streptococci is the only common cause of sore throat that
requires antibiotics, penicillin and erythromycin being the only recommended
treatment. However, 90% of sore throats are viral. The authors of this study

20. estimated there were 6.7 million adult annual visits for sore throat between 1989 and
1999 in the U.S. Antibiotics were used in 73% of visits. Furthermore, patients treated
with antibiotics were given non-recommended broad-spectrum antibiotics in 68% of
visits. The authors noted, that from 1989 to 1999, there was a significant increase in
the newer and more expensive broad-spectrum antibiotics and a decrease in use of
penicillin and erythromycin, which are the recommended antibiotics.54 If antibiotics
were given in 73% of visits and should have only been given in 10%, this represents
63%, or a total of 4.2 million visits for sore throat that ended in unnecessary antibiotic
prescriptions between1989-1999. In 1995, Dr. Besser and the CDC cited 2003 cited
much higher figures of 20 million unnecessary antibiotic prescriptions per year for
viral infections.2 Neither of these figures takes into account the number of
unnecessary antibiotics used for non-fatal conditions such as acne, intestinal
infection, skin infections, ear infections, etc.
The Problem with Antibiotics: They are Anti-Life
On September 17, 2003 the CDC relaunched a program, started in 1995, called “Get
Smart: Know When Antibiotics Work.”55 This is a $1.6 million campaign to educate
patients about the overuse and inappropriate use of antibiotics. Most people involved
with alternative medicine have known about the dangers of overuse of antibiotics for
decades. Finally the government is focusing on the problem, yet they are only putting
a miniscule amount of money into an iatrogenic epidemic that is costing billions of
dollars and thousands of lives. The CDC warns that 90% of upper respiratory
infections, including children’s ear infections, are viral, and antibiotics don’t treat viral
infection. More than 40% of about 50 million prescriptions for antibiotics each year in
physicians' offices were inappropriate.2 And using antibiotics, when not needed, can
lead to the development of deadly strains of bacteria that are resistant to drugs and
cause more than 88,000 deaths due to hospital-acquired infections.9 However, the
CDC seems to be blaming patients for misusing antibiotics even though they are only
available on prescription from a doctor who should know how to prescribe properly.
Dr. Richard Besser, head of “Get Smart,” says "Programs that have just targeted
physicians have not worked. Direct-to-consumer advertising of drugs is to blame in
some cases.” Dr. Besser says the program “teaches patients and the general public
that antibiotics are precious resources that must be used correctly if we want to have
them around when we need them. Hopefully, as a result of this campaign, patients

21. will feel more comfortable asking their doctors for the best care for their illnesses,
rather than asking for antibiotics."56
And what does the “best care” constitute? The CDC does not elaborate and patently
avoids the latest research on the dozens of nutraceuticals scientifically proven to
treat viral infections and boost the immune system. Will their doctors recommend
vitamin C, echinacea, elderberry, vitamin A, zinc, or homeopathic oscillococcinum?
No, they won’t. The archaic solutions offered by the CDC include a radio ad, “Just
Say No - Snort, sniffle, sneeze - No antibiotics please." Their commonsense
recommendations, that most people do anyway, include resting, drinking plenty of
fluids, and using a humidifier.
The pharmaceutical industry claims they are all for limiting the use of antibiotics. In
order to make sure that happens, the drug company Bayer is sponsoring a program
called, “Operation Clean Hands”, through an organization called LIBRA.57 The CDC
is also involved with trying to minimize antibiotic resistance, but nowhere in their
publications is there any reference to the role of nutraceuticals in boosting the
immune system nor to the thousands of journal articles that support this approach.
This recalcitrant tunnel vision and refusal to use available non-drug alternatives is
absolutely inappropriate when the CDC is desperately trying to curb the nightmare of
overuse of antibiotics. The CDC should also be called to task because it is only
focusing on the overuse of antibiotics. There are similar nightmares for every class of
drug being prescribed today.
Drugs Pollute Our Water Supply
We have reached the point of saturation with prescription drugs. We have arrived at
the point where every body of water tested contains measurable drug residues. We
are inundated with drugs. The tons of antibiotics used in animal farming, which run off
into the water table and surrounding bodies of water, are conferring antibiotic
resistance to germs in sewage, and these germs are also found in our water supply.
Flushed down our toilets are tons of drugs and drug metabolites that also find their
way into our water supply. We have no idea what the long-term consequences of
ingesting a mixture of drugs and drug-breakdown products will do to our health. It’s
another level of iatrogenic disease that we are unable to completely measure.58-67

22. Specific Drug Iatrogenesis: NSAIDs
It’s not just America that is plagued with iatrogenesis. A survey of 1072 French
general practitioners (GPs) tested their basic pharmacological knowledge and
practice in prescribing NSAIDs. Non-steroidal anti-inflammatory drugs (NSAIDs) rank
first among commonly prescribed drugs for serious adverse reactions. The results of
the study suggested that GPs don’t have adequate knowledge of these drugs and
are unable to effectively manage adverse reactions.68
A cross-sectional survey of 125 patients attending specialty pain clinics in South
London found that possible iatrogenic factors such as “over-investigation,
inappropriate information, and advice given to patients as well as misdiagnosis, over-
treatment, and inappropriate prescription of medication were common.”69
Specific Drug Iatrogenesis: Cancer Chemotherapy
In 1989, a German biostatistician, Ulrich Abel PhD, after publishing dozens of papers
on cancer chemotherapy, wrote a monograph “Chemotherapy of Advanced Epithelial
Cancer”. It was later published in a shorter form in a peer-reviewed medical journal.70
Dr. Abel presented a comprehensive analysis of clinical trials and publications
representing over 3,000 articles examining the value of cytotoxic chemotherapy on
advanced epithelial cancer. Epithelial cancer is the type of cancer we are most
familiar with. It arises from epithelium found in the lining of body organs such as
breast, prostate, lung, stomach, or bowel. From these sites cancer usually infiltrates
into adjacent tissue and spreads to bone, liver, lung, or the brain. With his exhaustive
review Dr. Abel concludes that there is no direct evidence that chemotherapy
prolongs survival in patients with advanced carcinoma. He said that in small-cell lung
cancer and perhaps ovarian cancer the therapeutic benefit is only slight. Dr. Abel
goes on to say, “Many oncologists take it for granted that response to therapy
prolongs survival, an opinion which is based on a fallacy and which is not supported
by clinical studies.”
Over a decade after Dr. Abel’s exhaustive review of chemotherapy, there seems no
decrease in its use for advanced carcinoma. For example, when conventional
chemotherapy and radiation has not worked to prevent metastases in breast cancer,
high-dose chemotherapy (HDC) along with stem-cell transplant (SCT) is the

23. treatment of choice. However, in March 2000, results from the largest multi-center
randomized controlled trial conducted thus far showed that, compared to a prolonged
course of monthly conventional-dose chemotherapy, HDC and SCT were of no
benefit.71 There was even a slightly lower survival rate for the HDC/SCT group. And
the authors noted that serious adverse effects occurred more often in the HDC group
than the standard-dose group. There was one treatment-related death (within 100
days of therapy) in the HDC group, but none in the conventional chemotherapy
group. The women in this trial were highly selected as having the best chance to
respond.
There is also no all-encompassing follow-up study like Dr. Abel’s that tells us if there
is any improvement in cancer-survival statistics since 1989. In fact, we need to
research whether chemotherapy itself is responsible for secondary cancers instead of
progression of the original disease. We continue to question why well-researched
alternative cancer treatments aren’t used.
Drug Companies Fined
Periodically, a drug manufacturer is fined by the FDA when the abuses are too
glaring and impossible to cover up. The May 2002 Washington Post reported that the
maker of Claritin, Schering-Plough Corp., was to pay a $500 million dollar fine to the
FDA for quality-control problems at four of its factories.72 The FDA tabulated
infractions that included 90%, or 125 of the drugs they made since 1998. Besides the
fine, the company had to stop manufacturing 73 drugs or suffer another $175 million
dollar fine. PR statements by the company told another story. The company assured
consumers that they should still feel confident in its products.
Such a large settlement serves as a warning to the drug industry about maintaining
strict manufacturing practices and has given the FDA more clout in dealing with drug
company compliance. According to the Washington Post article, a federal appeals
court ruled in 1999 that the FDA could seize the profits of companies that violate
"good manufacturing practices." Since that time Abbott Laboratories Inc. paid $100
million for failing to meet quality standards in the production of medical test kits, and
Wyeth Laboratories Inc. paid $30 million in 2000 to settle accusations of poor
manufacturing practices.

24. The indictment against Schering-Plough came after the Public Citizen Health
Research Group, lead by Dr. Sidney Wolfe, called for a criminal investigation of
Schering-Plough, charging that the company distributed albuterol asthma inhalers
even though it knew the units were missing the active ingredient.
UNNECESSARY SURGICAL PROCEDURES
Summary:
1974: 2.4 million unnecessary surgeries performed annually resulting in 11,900
deaths at an annual cost of $3.9 billion.73,74
2001: 7.5 million unnecessary surgical procedures resulting in 37,136 deaths at a
cost of $122 billion (using 1974 dollars).3
It’s very difficult to obtain accurate statistics when studying unnecessary surgery. Dr.
Leape in 1989 wrote that perhaps 30% of controversial surgeries are unnecessary.
Controversial surgeries include Cesarean section, tonsillectomy, appendectomy,
hysterectomy, gastrectomy for obesity, breast implants, and elective breast
implants.74
Almost thirty years ago, in 1974, the Congressional Committee on Interstate and
Foreign Commerce held hearings on unnecessary surgery. They found that 17.6% of
recommendations for surgery were not confirmed by a second opinion. The House
Subcommittee on Oversight and Investigations extrapolated these figures and
estimated that, on a nationwide basis, there were 2.4 million unnecessary surgeries
performed annually, resulting in 11,900 deaths at an annual cost of $3.9 billion.73
In 2001, the top 50 medical and surgical procedures totaled approximately 41.8
million. These figures were taken from the Healthcare Cost and Utilization Project
within the Agency for Healthcare Research and Quality.13 Using 17.6% from the 1974
U.S. Congressional House Subcommittee Oversight Investigation as the percentage
of unnecessary surgical procedures, and extrapolating from the death rate in 1974,
we come up with an unnecessary procedure number of 7.5 million (7,489,718) and a
death rate of 37,136, at a cost of $122 billion (using 1974 dollars).

25. Researchers performed a very similar analysis, using the 1974 ‘unnecessary surgery
percentage’ of 17.6, on back surgery. In 1995, researchers testifying before the
Department of Veterans Affairs estimated that of 250,000 back surgeries in the U.S.
at a hospital cost of $11,000 per patient, the total number of unnecessary back
surgeries each year in the U.S. could approach 44,000, costing as much as $484
million.75
The unnecessary surgery figures are escalating just as prescription drugs driven by
television advertising. Media-driven surgery such as gastric bypass for obesity
“modeled” by Hollywood personalities seduces obese people to think this route is
safe and sexy. There is even a problem of surgery being advertised on the Internet.76
A study in Spain declares that between 20 and 25% of total surgical practice
represents unnecessary operations.77
According to data from the National Center for Health Statistics from 1979 to 1984,
there was a 9% increase in the total number of surgical procedures, and the number
of surgeons grew by 20%. The author notes that there has not been a parallel
increase in the number of surgeries despite a recent large increase in the number of
surgeons. There was concern that there would be too many surgeons to share a
small surgical caseload.78
The previous author spoke too soon - there was no cause to worry about a small
surgical caseload. By 1994, there was an increase of 38% for a total of 7,929,000
cases for the top ten surgical procedures. In 1983, surgical cases totaled 5,731,000.
In 1994, cataract surgery was number one with over two million operations, and
second was Cesarean section (858,000 procedures). Inguinal hernia operations were
third (689,000 procedures), and knee arthroscopy, in seventh place, grew 153%
(632,000 procedures) while prostate surgery declined 29% (229,000 procedures).79
The list of iatrogenic diseases from surgery is as long as the list of procedures
themselves. In one study epidural catheters were inserted to deliver anesthetic into
the epidural space around the spinal nerves to block them for lower Cesarean
section, abdominal surgery, or prostate surgery. In some cases, non-sterile
technique, during catheter insertion, resulted in serious infections, even leading to
limb paralysis.80

26. In one review of the literature, the authors demonstrated “a significant rate of
overutilization of coronary angiography, coronary artery surgery, cardiac pacemaker
insertion, upper gastrointestinal endoscopies, carotid endarterectomies, back
surgery, and pain-relieving procedures.”81
A 1987 JAMA study found the following significant levels of inappropriate surgery:
17% of cases for coronary angiography, 32% for carotid endarterectomy, and 17%
for upper gastrointestinal tract endoscopy.82 Using the Healthcare Cost and
Utilization Project (HCUP) statistics provided by the government for 2001, the
number of people getting upper gastrointestinal endoscopy, which usually entails
biopsy, was 697,675; the number getting endarterectomy was 142,401; and the
number having coronary angiography was 719,949.13 Therefore, according to the
JAMA study 17%, or 118,604 people had an unnecessary endoscopy procedure.
Endarterectomy occurred in 142,401 patients; potentially 32% or 45,568 did not need
this procedure. And 17% of 719,949, or 122,391 people receiving coronary
angiography were subjected to this highly invasive procedure unnecessarily. These
are all forms of medical iatrogenesis.
MEDICAL AND SURGICAL PROCEDURES
It is instructive to know the mortality rate associated with different medical and
surgical procedures. Even though we must sign release forms when we undergo any
procedure, many of us are in denial about the true risks involved. We seem to hold a
collective impression that since medical and surgical procedures are so
commonplace, they are both necessary and safe. Unfortunately, partaking in
allopathic medicine itself is one of the highest causes of death as well as the most
expensive way to die.
Shouldn’t the daily death rate of iatrogenesis in hospitals, out of hospitals, in nursing
homes, and psychiatric residences be reported like the pollen count or the smog
index? Let’s stop hiding the truth from ourselves. It’s only when we focus on the
problem and ask the right questions can we hope to find solutions.
Perhaps the word “healthcare” gives us the illusion that medicine is about health.
Allopathic medicine is not a purveyor of healthcare but of disease-care. Studying the
mortality figures in the Healthcare Cost and Utilization Project (HCUP) within the U.S.

27. government’s Agency for Healthcare Research and Quality, we found many points of
interest.13 The HCUP computer program that calculates the annual mortality statistics
for all U.S. hospital discharges is only as good as the codes that are put into the
system. In an email correspondence with HCUP, we were told that the mortality rates
that were indicated in tables and charts for each procedure were not necessarily due
to the procedure but only indicated that someone who received that procedure died
either from their original disease or from the procedure.
Therefore there is no way of knowing exactly how many people died from a particular
procedure. There are also no codes for adverse drug side effects, none for surgical
mishap, and none for medical error. Until there are codes for medical error, statistics
of those people who are dying from various types of medical error will be buried in
the general statistics. There is a code for “poisoning & toxic effects of drugs” and a
code for “complications of treatment.” However, the mortality figures registered in
these categories are very low and don’t compare with what we know from studies
such as the JAMA 1998 study1 that said there were an average of 106,000
prescription medication deaths per year.
WHY AREN'T MEDICAL AND SURGICAL PROCEDURES STUDIED?
In 1978, the U.S. Office of Technology Assessment (OTA) reported that, “Only 10%-
20% of all procedures currently used in medical practice have been shown to be
efficacious by controlled trial."83 In 1995, the OTA compared medical technology in
eight countries (Australia, Canada, France, Germany, Netherlands, Sweden, United
Kingdom, and the United States) and again noted that few medical procedures in the
U.S. had been subjected to clinical trial. It also reported that infant mortality was high
and life expectancy was low compared to other developed countries.84 Although
almost ten years old, much of what was said in this report holds true today. The
report lays the blame for the high cost of medicine squarely at the feet of the medical
free-enterprise system and the fact that there is no national health care policy. It
describes the failure of government attempts to control health care costs due to
market incentive and profit motive in the financing and organization of health care
including private insurance, hospital system, physician services, and drug and
medical device industries. Whereas we may want to expand health-care, expansion
of disease-care is the goal of free enterprise. “Health Care Technology and Its

28. Assessment in Eight Countries” is also the last report prepared by the OTA, which
was shut down in 1995. It’s also, perhaps, the last honest, in-depth look at modern
medicine. Because of the importance of this 60-page report, we enclose a summary
in the Appendix.
SURGICAL ERRORS FINALLY REPORTED
Just hours before completion of this paper, statistics on surgical-related deaths
became available. A October 8, 2003 JAMA study from the U.S. government’s
Agency for Healthcare Research and Quality (AHRQ) documented 32,000 mostly
surgery-related deaths costing $9 billion and accounting for 2.4 million extra days in
the hospital in 2000.85 In a press release accompanying the JAMA study, the AHRQ
director, Carolyn M. Clancy, M.D., admitted, “This study gives us the first direct
evidence that medical injuries pose a real threat to the American public and increase
the costs of health care.” 86 Hospital administrative data from 20% of the nation’s
hospitals were analyzed for eighteen different surgical complications including
postoperative infections, foreign objects left in wounds, surgical wounds reopening,
and post-operative bleeding. In the same press release the study’s authors said that,
“The findings greatly underestimate the problem, since many other complications
happen that are not listed in hospital administrative data.” They also felt that, "The
message here is that medical injuries can have a devastating impact on the health
care system. We need more research to identify why these injuries occur and find
ways to prevent them from happening." One of the authors, Dr. Zhan said that
improved medical practices, including an emphasis on better hand-washing, might
help reduce the morbidity and mortality rates. An accompanying JAMA editorial by
health-risk researcher Dr. Saul Weingart of Harvard’s Beth Israel Deaconess Medical
Center said, “Given their staggering magnitude, these estimates are clearly
sobering.”87
UNNECESSARY X-RAYS
When X-rays were discovered, no one knew the long-term effects of ionizing
radiation. In the 1950’s monthly fluoroscopic exams at the doctor’s office were
routine. You could even walk into most shoe stores and see your foot bones; looking

29. at bones was an amusing novelty. We still don’t know the ultimate outcome of our
initial escapade with X-rays.
It was common practice to use X-rays in pregnant women to measure the size of the
pelvis, and make a diagnosis of twins. Finally, a study of 700,000 children born
between 1947 and 1964 was conducted in thirty-seven major maternity hospitals.
The children of mothers who had received pelvic X-rays during pregnancy were
compared with the children of mothers who had not been X-rayed. Cancer mortality
was 40% higher among the children with X-rayed mothers.88
In present-day medicine, coronary angiography combines an invasive surgical
procedure of snaking a tube through a blood vessel in the groin up to the heart. To
get any useful information during the angiography procedure X-rays are taken almost
continuously with minimum dosage ranges between 460 - 1,580 mrem. The minimum
radiation from a routine chest X-ray is 2 mrem. X-ray radiation accumulates in the
body and it is well-known that ionizing radiation used in X-ray procedures causes
gene mutation. We can only obtain guesstimates as to its impact on health from this
high level of radiation. Experts manage to obscure the real effects in statistical jargon
such as, “The risk for lifetime fatal cancer due to radiation exposure is estimated to
be 4 in one million per 1,000 mrem.”89
However, Dr. John Gofman, who has been studying the effects of radiation on human
health for 45 years, is prepared to tell us exactly what diagnostic X-rays are doing to
our health. Dr. Gofman has a PhD in nuclear and physical chemistry and is a medical
doctor. He worked on the Manhattan nuclear project, discovered uranium-2323, was
the first person to isolate plutonium, and since 1960, he’s been studying the effects of
radiation on human health. With five scientifically documented books totaling over
2800 pages, Dr. Gofman provides strong evidence that medical technology,
specifically X-rays, CT scans, mammography, and fluoroscopy, are a contributing
factor to 75% of new cancers. His 699-page report, updated in 2000, “Radiation from
Medical Procedures in the Pathogenesis of Cancer and Ischemic Heart Disease:
Dose-Response Studies with Physicians per 100,000 Population to here”90 shows
that as the number of physicians increases in a geographical area with an increase in
the number of X-ray diagnostic tests, there is an associated increase in the rate of
cancer and ischemic heart disease. Dr. Gofman elaborates that it’s not X-rays alone

30. that cause the damage but a combination of health risk factors including: poor diet,
smoking, abortions, and the use of birth control pills. Dr. Gofman predicts that 100
million premature deaths over the next decade will be the result of ionizing radiation.
In his book, “Preventing Breast Cancer,” Dr. Gofman says that breast cancer is the
leading cause of death among American women between the ages of forty-four and
fifty-five. Because breast tissue is highly radiation-sensitive, mammograms can
cause cancer. The danger can be heightened by a woman’s genetic makeup,
preexisting benign breast disease, artificial menopause, obesity, and hormonal
imbalance.91
Even X-rays for back pain can lead someone into crippling surgery. Dr. Sarno, a well-
known New York orthopedic surgeon, found that X-rays don’t always tell the truth. In
his books he cites studies on normal people without a trace of back pain that have
spinal abnormalities on X-ray. Other studies have shown that some people with back
pain have normal spines on X-ray. So, Dr. Sarno says there is not necessarily any
association between back pain and spinal X-ray abnormality.92 However, if a person
happens to have back pain and an incidental abnormality on X-ray, they may be
treated surgically, sometimes with no change in back pain, or worsening of back pain,
or even permanent disability.
In addition, doctors often order X-rays as protection against malpractice claims to
give the impression that they are leaving no stone unturned. It appears that doctors
are putting their own fears before the interests of their patients.
UNNECESSARY HOSPITALIZATION
Summary:
8.9 million (8,925,033) people were hospitalized unnecessarily in 2001.4
In a study of inappropriate hospitalization 1,132 medical records were reviewed by
two doctors. Twenty-three percent of all admissions were inappropriate and an
additional 17% could have been handled in ambulatory out-patient clinics. Thirty-four
percent of all hospital days were also inappropriate and could have been avoided.93
The rate of inappropriate admissions in 1990 was 23.5%.94 In 1999, another study

31. confirmed the figure of 24% inappropriate admissions indicating a consistent pattern
from 1986 to 1999,95 showing steady reporting of approximately 24% inappropriate
admissions each year. Putting these figures into present-day terms using the HCUP
database, the total number of patient discharges from hospitals in the U.S. in 2001
was 37,187,641.13 The above data indicate that 24% of those hospitalizations need
never have occurred. It further means that 8,925,033 people were exposed to
unnecessary medical intervention in hospitals and therefore represent almost 9
million potential iatrogenic episodes.4
WOMEN'S EXPERIENCE IN MEDICINE
Briefly, we will look at the medical iatrogenesis of women in particular. Dr. Martin
Charcot (1825-1893) was world-renowned, the most celebrated doctor of his time. He
practiced in the Paris hospital La Salpetriere. He became an expert in hysteria
diagnosing an average of ten hysterical women each day, transforming them into…
“iatrogenic monsters,” turning simple ‘neurosis’ into hysteria.96 The number of women
diagnosed with hysteria and hospitalized rose from 1% in 1841 to 17% in 1883.
Hysteria is derived from the Latin “hystera” meaning uterus. Dr. Adriane Fugh-
Berman stated very clearly in her paper that there is a tradition in U.S. medicine of
excessive medical and surgical interventions on women. Only one hundred years ago
male doctors decided that female psychological imbalance originated in the uterus.
When surgery to remove the uterus was perfected it became the “cure” for mental
instability, effecting a physical and psychological castration. Dr. Fugh-Berman noted
that U.S. doctors eventually disabused themselves of that notion but have continued
to treat women very differently than they treat men.97 She cites the following:
1. Thousands of prophylactic mastectomies are performed annually.
2. One-third of U.S. women have had a hysterectomy before menopause.
3. Women are prescribed drugs more frequently than are men.
4. Women are given potent drugs for disease prevention, which results in
disease substitution due to side effects.
5. Fetal monitoring is unsupported by studies and not recommended by the
CDC.98 It confines women to a hospital bed and may result in higher incidence
of Cesarean section.99

32. 6. Normal processes such as menopause and childbirth have been heavily
medicalized.
7. Synthetic hormone replacement therapy (HRT) does not prevent heart disease
or dementia. It does increase the risk of breast cancer, heart disease, stroke,
and gall bladder attack.100
We would add that as many as one-third of postmenopausal women use HRT.101,102
These numbers are important in light of the much-publicized Women’s Health
Initiative Study, which was forced to stop before its completion because of a higher
death rate in the synthetic estrogen-progestin (HRT) group.103
Cesarean Section
In 1983, 809,000 Cesarean sections (21% of live births) were performed, making it
the most common obstetric and gynecologic (OB/GYN) surgical procedure. The
second most common OB/GYN operation was hysterectomy (673,000), and
diagnostic dilation and curettage of the uterus (632,000) was third. In 1983, OB/GYN
operations represented 23% of all surgery completed in this country.104
In 2001, Cesarean section is still the most common OB/GYN surgical procedure.
Approximately 4 million births occur annually, with a 24% C-Section rate, i.e.,
960,000 operations. In the Netherlands only 8% of babies are delivered by Cesarean
section. Assuming human babies are similar in the U.S. and in the Netherlands, we
are performing 640,000 unnecessary C-Sections in the U.S. with its three to four
times higher mortality and 20 times greater morbidity than vaginal delivery.105
The Cesarean section rate was only 4.5% in the U.S. in 1965. By 1986 it had climbed
to 24.1%. The author states that obviously an “uncontrolled pandemic of medically
unnecessary Cesarean births is occurring.”106 VanHam reported a Cesarean section
postpartum hemorrhage rate of 7%, a hematoma formation rate of 3.5%, a urinary
tract infection rate of 3%, and a combined postoperative morbidity rate of 35.7% in a
high-risk population undergoing Cesarean section.107
NEVER ENOUGH STUDIES

33. Scientists used the excuse that there were never enough studies revealing the
dangers of DDT and other dangerous pesticides to ban them. They also used this
excuse around the issue of tobacco, claiming that more studies were needed before
they could be certain that tobacco really caused lung cancer. Even the American
Medical Association (AMA) was complicit in suppressing results of tobacco research.
In 1964, the Surgeon General's report condemned smoking, however the AMA
refused to endorse it. What was their reason? They needed more research. Actually
what they really wanted was more money and they got it from a consortium of
tobacco companies who paid the AMA $18 million over the next nine years, during
which the AMA said nothing about the dangers of smoking.108
The Journal of the American Medical Association (JAMA), "after careful consideration
of the extent to which cigarettes were used by physicians in practice," began
accepting tobacco advertisements and money in 1933. State journals such as the
New York State Journal of Medicine also began to run Chesterfield ads claiming that
cigarettes are, "Just as pure as the water you drink… and practically untouched by
human hands." In 1948, JAMA argued "more can be said in behalf of smoking as a
form of escape from tension than against it… there does not seem to be any
preponderance of evidence that would indicate the abolition of the use of tobacco as
a substance contrary to the public health."109 Today, scientists continue to use the
excuse that they need more studies before they will lend their support to restrict the
inordinate use of drugs.
OVERVIEW OF STATISTICAL TABLES AND FIGURES
Adverse Drug Reactions
The Lazarou study1 was based on statistical analysis of 33 million U.S. hospital
admissions in 1994. Hospital records for prescribed medications were analyzed. The
number of serious injuries due to prescribed drugs was 2.2 million; 2.1% of in-
patients experienced a serious adverse drug reaction; 4.7% of all hospital admissions
were due to a serious adverse drug reaction; and fatal adverse drug reactions
occurred in 0.19% of in-patients and 0.13% of admissions. The authors concluded
that a projected 106,000 deaths occur annually due to adverse drug reactions.

34. We used a cost analysis from a 2000 study in which the increase in hospitalization
costs per patient suffering an adverse drug reaction was $5,483. Therefore, costs for
the Lazarou study’s 2.2 million patients with serious drug reactions amounted $12
billion.1,49
Serious adverse drug reactions commonly emerge after Food and Drug
Administration approval. The safety of new agents cannot be known with certainty
until a drug has been on the market for many years.110
Bedsores
Over one million people develop bedsores in U.S. hospitals every year. It’s a
tremendous burden to patients and family, and a $55 billion dollar healthcare
burden.7 Bedsores are preventable with proper nursing care. It is true that 50% of
those affected are in a vulnerable age group of over 70. In the elderly bedsores carry
a fourfold increase in the rate of death. The mortality rate in hospitals for patients with
bedsores is between 23% and 37%.8 Even if we just take the 50% of people over 70
with bedsores and the lowest mortality at 23%, that gives us a death rate due to
bedsores of 115,000. Critics will say that it was the disease or advanced age that
killed the patient, not the bedsore, but our argument is that an early death, by
denying proper care, deserves to be counted. It is only after counting these
unnecessary deaths that we can then turn our attention to fixing the problem.
Malnutrition in Nursing Homes
The General Accounting Office (GAO), a special investigative branch of Congress,
gave citations to 20% of the nation's 17,000 nursing homes for violations between
July 2000 and January 2002. Many violations involved serious physical injury and
death.111
A report from the Coalition for Nursing Home Reform states that at least one-third of
the nation’s 1.6 million nursing home residents may suffer from malnutrition and
dehydration, which hastens their death. The report calls for adequate nursing staff to
help feed patients who aren’t able to manage a food tray by themselves.11 It is
difficult to place a mortality rate on malnutrition and dehydration. This Coalition report
states that malnourished residents, compared with well-nourished hospitalized

35. nursing home residents, have a five-fold increase in mortality when they are admitted
to hospital. So, if we take one-third of the 1.6 million nursing home residents who are
malnourished and multiply that by a mortality rate of 20%,8,14 we find 108,800
premature deaths due to malnutrition in nursing homes.
Nosocomial Infections
The rate of nosocomial infections per 1,000 patient days has increased 36% - from
7.2 in 1975 to 9.8 in 1995. Reports from more than 270 U.S. hospitals showed that
the nosocomial infection rate itself had remained stable over the previous 20 years
with approximately five to six hospital-acquired infections occurring per 100
admissions, which is a rate of 5-6%. However, because of progressively shorter
inpatient stays and the increasing number of admissions, the actual number of
infections increased. It is estimated that in 1995, nosocomial infections cost $4.5
billion and contributed to more than 88,000 deaths - one death every 6 minutes.9 The
2003 incidence of nosocomial mortality is quite probably higher than in 1995 because
of the tremendous increase in antibiotic-resistant organisms. Morbidity and Mortality
Report found that nosocomial infections cost $5 billion annually in 1999.10 This is a
$0.5 billion increase in four years. The present cost of nosocomial infections might
now be in the order of $5.5 billion.
Outpatient Iatrogenesis
Dr. Barbara Starfield in a 2000 JAMA paper presents us with well-documented facts
that are both shocking and unassailable.12
1. The U.S. ranks twelfth out of 13 countries in a total of 16 health indicators.
Japan, Sweden, and Canada were first, second, and third.
2. More than 40 million people have no health insurance.
3. 20% to 30% of patients receive contraindicated care.
Dr. Starfield warns that one cause of medical mistakes is the overuse of technology,
which may create a "cascade effect" leading to more treatment. She urges the use of
ICD (International Classification of Diseases) codes which have designations called:
"Drugs, Medicinal, and Biological Substances Causing Adverse Effects in
Therapeutic Use" and "Complications of Surgical and Medical Care" to help doctors

36. quantify and recognize the magnitude of the medical error problem. Starfield says
that, at present, deaths actually due to medical error are likely to be coded according
to some other cause of death.
She concludes that against the backdrop of our abysmal health report card compared
to the rest of the Westernized countries, we should recognize that the harmful effects
of health care interventions account for a substantial proportion of our excess deaths.
Starfield cites Weingart’s 2000 paper, “Epidemiology of Medical Error” on outpatient
iatrogenesis. And Weingart, in turn, cites Johnson and Bootman, who asked pharmacists to
estimate the probability of adverse outcomes occurring as a result of outpatient drug
treatment. Statistics showed that between 4% to 18% of consecutive patients in outpatient
settings suffer an iatrogenic event leading to:112
1. 116 million extra physician visits
2. 77 million extra prescriptions
3. 17 million emergency department visits
4. 8 million hospitalizations
5. 3 million long-term admissions
6. 199,000 additional deaths
7. $77 billion in extra costs
Unnecessary Surgeries
There are 12,000 deaths per year from unnecessary surgeries. However, results from
the few studies that have measured unnecessary surgery directly indicate that for
some highly controversial operations, the fraction that are unwarranted could be as
high as 30%.74
IT'S A GLOBAL ISSUE
A survey published in the Journal of Health Affairs pointed out that between 18% and
28% of people who were recently ill had suffered from a medical or drug error in the
previous two years. The study surveyed 750 recently-ill adults in five different
countries. The breakdown by country showed 18% of those in Britain, 25% in
Canada, 23% in Australia, 23% in New Zealand, and the highest number was in the
U.S. at 28%.113

37. HEALTH INSURANCE
A recent finding by the Institute of Medicine is that the 41 million Americans without
health insurance have consistently worse clinical outcomes than those that are
insured, and are at increased risk for dying prematurely.114
Insurance Fraud
When doctors bill for services they do not render, advise unnecessary tests, or
screen everyone for a rare condition, they are committing insurance fraud. The U.S.
General Accounting Office (GAO) gave a 1998 figure of $12 billion dollars lost to
fraudulent or unnecessary claims, and reclaimed $480 million in judgments in that
year. In 2001, the Federal government won or negotiated more than $1.7 billion in
judgments, settlements, and administrative impositions in healthcare fraud cases and
proceedings.115
WAREHOUSING OUR ELDERS
It is only fitting that we end this report with acknowledgement of our elders. The moral
and ethical fiber of society can be judged by the way it treats its weakest and most
vulnerable members. Some cultures honor and respect the wisdom of their elders,
keeping them at home – the better to continue participation in their community.
However, American nursing homes, where millions of our elders die, represent the
pinnacle of social isolation and medical abuse.
Important Statistics about Nursing Homes
1. In America, at any one time, approximately 1.6 million elderly are confined to
nursing homes. By 2050 that number could be 6.6 million.11,116
2. A total of 20% of all deaths from all causes occur in nursing homes.117
3. Hip fractures are the single greatest reason for nursing home admissions.118
Nursing homes represent a reservoir for drug-resistant organisms due to
overuse of antibiotics.119

38. Congressman Waxman reminded us that “as a society we will be judged by how we
treat the elderly" when he presented a report that he sponsored, "Abuse of Residents
is a Major Problem in U.S. Nursing Homes," on July 30, 2001. The report uncovered
that one third - 5,283 of the nations’ 17,000 nursing homes - were cited for an abuse
violation in the two-year period studied, January 1999 - January 2001.116 Waxman
stated that “the people who cared for us, deserve better." He also made it very clear
that this was only the tip of the iceberg and there is much more abuse occurring that
we don’t know about or ignore.116a
The major findings of "Abuse of Residents is a Major Problem in U.S. Nursing
Homes," were:
1. Over 30% of nursing homes in the U.S. were cited for abuses, totaling more
than 9,000 abuse violations.
2. 10% of nursing homes had violations that caused actual physical harm to
residents, or worse.
3. Over 40%, or 3,800 abuse violations were only discovered after a formal
complaint was filed, usually by concerned family members.
4. Many verbal abuse violations were found.
5. Occasions of sexual abuse.
6. Incidents of physical abuse causing numerous injuries such as fractured
femur, hip, elbow, wrist, and other injuries.
Dangerously understaffed nursing homes lead to neglect, abuse, overuse of
medications, and physical restraints. An exhaustive study of nurse-to-patient ratios in
nursing homes was mandated by Congress in 1990. The study was finally begun in
1998 and took four years to complete.120 Commenting on the study, a spokesperson
for The National Citizens’ Coalition for Nursing Home Reform said, “They compiled
two reports of three volumes each thoroughly documenting the number of hours of
care residents must receive from nurses and nursing assistants to avoid painful, even
dangerous, conditions such as bedsores and infections. Yet it took the Department of
Health and Human Services and Secretary Tommy Thompson only four months to
dismiss the report as ‘insufficient.’”121 Bedsores occur three times more commonly in
nursing homes than in acute care or veterans’ hospitals.122 But we know that
bedsores can be prevented with proper nursing care. It shouldn’t take four years for

39. someone to find out that proper care of bedsores requires proper staffing. In spite of
such urgent need in nursing homes where additional staff could solve so many
problems, we hear the familiar refrain “not enough research” - one that merely buys
time for those in charge and relegates another smoldering crisis to the back burner.
Since many nursing home patients suffer from chronic debilitating conditions, their
assumed cause of death is often unquestioned by physicians. Some studies show
that as many as 50% of deaths due to restraints, falls, suicide, homicide, and choking
in nursing homes may be covered up.123,124 It is quite possible that many nursing
home deaths are attributed, instead, to heart disease, which, until our report, was the
number one cause of death. In fact, researchers have found that heart disease may
be over-represented in the general population as a cause of death on death
certificates by 7.9% to 24.3%. In the elderly the over-reporting of heart disease as a
cause of death is as much as two-fold.125
When elucidating iatrogenesis in nursing homes, some critics have asked, “To what
extent did these elderly people already have life-threatening diseases that led to their
premature deaths anyway?” Our response is that if a loved one dies one day, one
week, one year, a decade, or two decades prematurely, thanks to some medical
misadventure, that is still a premature, iatrogenic death. In a legalistic sense perhaps
more weight is placed on the loss of many potential years compared to an additional
few weeks, but this attitude is not justified in an ethical or moral sense.
The fact that there are very few statistics on malnutrition in acute-care hospitals and
nursing homes shows the lack of concern in this area. A survey of the literature turns
up very few American studies. Those that do appear are foreign studies in Italy,
Spain, and Brazil. However, there is one very revealing American study conducted
over a 14-month period that evaluated 837 patients in a 100-bed sub-acute-care
hospital for their nutritional status. Only 8% of the patients were found to be well
nourished. Almost one-third (29%) were malnourished and almost two-thirds (63%)
were at risk of malnutrition. The consequences of this state of deficiency were that
25% of the malnourished patients required readmission to an acute-care hospital
compared to 11% of the well-nourished patients. The authors concluded that
malnutrition reached epidemic proportions in patients admitted to this sub-acute-care
facility.126

40. Many studies conclude that physical restraints are an underreported and preventable
cause of death. Whereas administrators say they must use restraints to prevent falls,
in fact, they cause more injury and death because people naturally fight against such
imprisonment. Studies show that compared to no restraints, the use of restraints
carries a higher mortality rate and economic burden.127-129 Studies found that physical
restraints, including bedrails, are the cause of at least 1 in every 1,000 nursing-home
deaths.130-132
However, deaths caused by malnutrition, dehydration, and physical restraints are
rarely recorded on death certificates. Several studies reveal that nearly half of the
listed causes of death on death certificates for older persons with chronic or multi-
system disease are inaccurate.133 Even though 1-in-5 people die in nursing homes,
the autopsy rate is only 0.8%.134 Thus, we have no way of knowing the true causes of
death.
Over-medicating Seniors
The CDC may be focused on reducing the number of prescriptions for children but a
2003 study finds over-medication of our elderly population. Dr. Robert Epstein, chief
medical officer of Medco Health Solutions Inc. (a unit of Merck & Co.), conducted the
study on drug trends.135 He found that seniors are going to multiple physicians and
getting multiple prescriptions and using multiple pharmacies. Medco oversees drug-
benefit plans for more than 60 million Americans, including 6.3 million senior citizens
who received more than 160 million prescriptions. According to the study, the
average senior receives 25 prescriptions annually. In those 6.3 million seniors, a total
of 7.9 million medication alerts were triggered: less than one-half that number, 3.4
million, were detected in 1999. About 2.2 million of those alerts indicated excessive
dosages unsuitable for senior citizens, and about 2.4 million alerts indicated clinically
inappropriate drugs for the elderly. Reuters interviewed Kasey Thompson, director of
the Center on Patient Safety at the American Society of Health System Pharmacists,
who said, “There are serious and systemic problems with poor continuity of care in
the United States.” He says this study shows “the tip of the iceberg” of a national
problem.

41. According to Drug Benefit Trends, the average number of prescriptions dispensed
per non-Medicare HMO member per year rose 5.6% from 1999 to 2000 - from 7.1 to
7.5 prescriptions. The average number dispensed for Medicare members increased
5.5% - from 18.1 to 19.1 prescriptions.136 The number of prescriptions in 2000 was
2.98 billion, with an average per person prescription amount of 10.4 annually.137
In a study of 818 residents of residential care facilities for the elderly, 94% were
receiving at least one medication at the time of the interview. The average intake of
medications was five per resident; the authors noted that many of these drugs were
given without a documented diagnosis justifying their use.138
Unfortunately, seniors, and groups like the American Association for Retired Persons
(AARP), appear to be dependent on prescription drugs and are demanding that
coverage for drugs be a basic right.139 They have accepted the overriding assumption
from allopathic medicine that aging and dying in America must be accompanied by
drugs in nursing homes and eventual hospitalization with tubes coming out of every
orifice. Instead of choosing between drugs and a diet-lifestyle change, seniors are
given the choiceless option of either high-cost patented drugs or low-cost generic
drugs. Drug companies are attempting to keep the most expensive drugs on the
shelves and to suppress access to generic drugs, in spite of stiff fines of hundreds of
millions of dollars from the government.140,141 In 2001 some of the world's biggest
drug companies, including Roche, were fined a record £523 million ($871 million) for
conspiring to increase the price of vitamins.142
We would urge AARP, especially, to become more involved in prevention of disease
and not to rely so heavily on drugs. At present, the AARP recommendations for diet
and nutrition assume that seniors are getting all the nutrition they need in an average
diet. At most, they suggest extra calcium and a multiple vitamin/mineral
supplement.143 This is not enough, and in our next report we will show how to live a
healthier life without unnecessary medical intervention.
We would like to send the same message to the Hemlock Society, which offers
euthanasia options to chronically ill people, especially those in severe pain. What if
some of these chronic diseases are really lifestyle diseases caused by deficiency of
essential nutrients, lack of care, inappropriate medication, or lack of love? This

42. question is extremely important to consider when you are depressed or in pain. We
must look to healing those conditions before offering up our lives.
Let’s also look at the irony of under use of proper pain medication for patients that
really need it. For example, in one particular study pain management was evaluated
in a group of 13,625 cancer patients, aged 65 or over, living in nursing homes.
Overall, almost 30%, or 4,003 patients, reported pain. However, more than 25%
received absolutely no pain relief medication; 16% received a World Health
Organization (WHO) level-one drug (mild analgesic); 32% a WHO level-two drug
(moderate analgesic); and only 26% received adequate pain relieving morphine. The
authors concluded that older patients and minority patients were more likely to have
their pain untreated.144
The time has come to set a standard for caring for the vulnerable among us - a
standard that goes beyond making sure they are housed and fed, and not openly
abused. We must stop looking the other way and we, as a society, must take
responsibility for the way in which we deal with those who are unable to care for
themselves.
WHAT REMAINS TO BE UNCOVERED
Our ongoing research will continue to quantify the morbidity, mortality, and financial
loss due to:
1. X-ray exposures: mammography, fluoroscopy, CT scans.
2. Overuse of antibiotics in all conditions.
3. Drugs that are carcinogenic: hormone replacement therapy (*see below),
immunosuppressive drugs, prescription drugs.
4. Cancer chemotherapy: If it doesn’t extend life, is it shortening life?70
5. Surgery and unnecessary surgery: Cesarean section, radical mastectomy,
preventive mastectomy, radical hysterectomy, prostatectomy,
cholecystectomies, cosmetic surgery, arthroscopy, etc.
6. Discredited medical procedures and therapies.
7. Unproven medical therapies.
8. Outpatient surgery.

43. 9. Doctors themselves: when doctors go on strike, it appears the mortality rate
goes down.
*Part of our ongoing research will be to quantify the mortality and morbidity caused
by hormone replacement therapy (HRT) since the mid-1940’s. In December 2000, a
government scientific advisory panel recommended that synthetic estrogen be added
to the nation's list of cancer-causing agents. HRT, either synthetic estrogen alone or
combined with synthetic progesterone, is used by an estimated 13.5 to 16 million
women in the U.S.145 The aborted Women’s Health Initiative Study (WHI) of 2002
showed that women taking synthetic estrogen combined with synthetic progesterone
have a higher incidence of ovarian cancer, breast cancer, stroke, and heart disease
and little evidence of osteoporosis reduction or prevention of dementia. WHI
researchers, who usually never give recommendations, other than demanding more
studies, are advising doctors to be very cautious about prescribing HRT to their
patients.100,146-150
Results of the “Million Women Study” on HRT and breast cancer in the U.K were
published in the Lancet, August, 2003. Lead author, Professor Valerie Beral, Director
of the Cancer Research UK Epidemiology Unit, is very open about the damage HRT
has caused. She said, "We estimate that over the past decade, use of HRT by UK
women aged 50-64 has resulted in an extra 20,000 breast cancers, oestrogen-
progestagen (combination) therapy accounting for 15,000 of these.”151 However, we
were not able to find the statistics on breast cancer, stroke, uterine cancer, or heart
disease due to HRT used by American women. The population of America is roughly
six times that of the U.K. Therefore, it is possible that 120,000 cases of breast cancer
have been caused by HRT in the past decade.
CONCLUSION
When the number one killer in a society is the healthcare system, then, that system
has no excuse except to address its own urgent shortcomings. It’s a failed system in
need of immediate attention. What we have outlined in this paper are insupportable
aspects of our contemporary medical system that need to be changed - beginning at
its very foundations.
REFERENCES

44. 1. Lazarou J, Pomeranz B, Corey P. Incidence of adverse drug reactions in
hospitalized patients. JAMA. 1998;279:1200-1205.
2. Rabin R. Caution About Overuse of Antibiotics. Newsday. Sept. 18, 2003.
2a. http://www.cdc.gov/drugresistance/community/
3. Calculations detailed in Unnecessary Surgery section, from two sources: (13)
http://hcup.ahrq.gov/HCUPnet.asp and (71) US Congressional House Subcommittee
Oversight Investigation. Cost and Quality of Health Care: Unnecessary Surgery.
Washington, DC: Government Printing Office, 1976
4. Calculations from four sources, see Unnecessary Hospitalization section: (13)
http://hcup.ahrq.gov/HCUPnet.asp and (93) Siu AL, Sonnenberg FA, Manning WG,
Goldberg GA, Bloomfield ES, Newhouse JP, Brook RH. Inappropriate use of
hospitals in a randomized trial of health insurance plans. NEJM. 1986 Nov
13;315(20):1259-66. and (94) Siu AL, Manning WG, Benjamin B. Patient, provider
and hospital characteristics associated with inappropriate hospitalization. Am J Public
Health. 1990 Oct;80(10):1253-6. and (95) Eriksen BO, Kristiansen IS, Nord E, Pape
JF, Almdahl SM, Hensrud A, Jaeger S. The cost of inappropriate admissions: a study
of health benefits and resource utilization in a department of internal medicine. J
Intern Med. 1999 Oct;246(4):379-87.
5. National Vital Statistics Reports. Vol. 51, No. 5, March 14, 2003.
6. Thomas et al., 2000; Thomas et al., 1999. Institute of Medicine.
7. Xakellis, G.C., R. Frantz and A. Lewis, Cost of Pressure Ulcer Prevention in Long
Term Care, JAGS, 43 - 5, May 1995.)
8. Barczak, C.A., R.I. Barnett, E.J. Childs, L.M. Bosley, "Fourth National Pressure
Ulcer Prevalence Survey", Advances in Wound Care, 10- 4, Jul/Aug 1997
9. Weinstein RA. Nosocomial Infection Update. Special Issue. Emerging Infectious
Diseases. Vol 4 No. 3, July Sept 1998.
10. Forth Decennial International Conference on Nosocomial and Healthcare-
Associated Infections, Morbidity and Mortality Weekly Report (MMWR), February 25,
2000, Vol. 49, No. 7, p. 138.
11. Greene Burger S, Kayser-Jones J, Prince Bell J. Malnutrition and Dehydration in
Nursing Homes:Key Issues in Prevention and Treatment. National Citizens' Coalition
for Nursing Home Reform. June 2000.
http://www.cmwf.org/programs/elders/burger_mal_386.asp
12. Starfield B. Is US health really the best in the world? JAMA. 2000 Jul

45. 26;284(4):483-5. Starfield B. Deficiencies in US medical care. JAMA. 2000 Nov
1;284(17):2184-5.
13. HCUPnet, Healthcare Cost and Utilization Project for the Agency for Healthcare
Research and Quality. http://www.ahrq.gov/data/hcup/hcupnet.htm,
http://hcup.ahrq.gov/HCUPnet.asp, http://hcup.ahrq.gov/HCUPnet.asp
14. Leape L. National Patient Safety Foundation Press Release. Nationwide Poll on
Patient Safety Oct 9, 1997 New York. http://www.npsf.org/html/pressrel/finalgen.html
15. The Troubled Healthcare System in the U.S. The Society of Actuaries: Health
Benefit Systems Practice Advancement Committee. Sept. 13, 2003.
http://www.soa.org/
16. Leape LL. Error in medicine. JAMA. 1994 Dec 21;272(23):1851-7.
16a.Brennan TA, Leape LL, Laird NM, Hebert L, Localio AR, Lawthers AG, et al.
Incidence of adverse events and negligence in hospitalized patients. N Engl J Med
1991; 324: 370-376.)
17. Campbell EG, Weissman JS, Clarridge B, Yucel R, Causino N, Blumenthal D.
Characteristics of medical school faculty members serving on institutional review
boards: results of a national survey. Acad Med. 2003 Aug;78(8):831-6.
18. Possible Conflict of Interest Within Medical Profession. Aug. 15, 2003
HealthDayNews.
19. World Health Organization, Press Release Bulletin #9, December 17, 2001.
20. Angell M. Is academic medicine for sale? N Engl J Med. 2000 May
18;342(20):1516-8.
21. McKenzie J. Conflict of Interest? Medical Journal Changes Policy of Finding
Independent Doctors. June 12, 2002. ABC News.
22. Crossen C. Tainted Truth: The Manipulation of Fact in America. 1996.
Touchstone Books.
23. Bates DW, Cullen DJ, Laird N, Petersen LA, Small SD, Servi D, Laffel G,
Sweitzer BJ, Shea BF, Hallisey R, et al. Incidence of adverse drug events and
potential adverse drug events. Implications for prevention. ADE Prevention Study
Group. JAMA. 1995 Jul 5;274(1):29-34.
24. Vincent C, Stanhope N, Crowley-Murphy M. Reasons for not reporting adverse
incidents: an empirical study. J Eval Clin Pract. 1999 Feb;5(1):13-21.
25. Wald, H and Shojania, K. Incident Reporting in Making Health Care Safer: A
Critical Analysis of Patient Safety Practices, Agency for Healthcare Research and

46. Quality (AHRQ), 2001.
26. Grinfeld MJ. The Debate Over Medical Error Reporting. Psychiatric Times, April
2000. Vol. XVII Issue 4.
27. King, G. III, & Hermodson, A. Peer reporting of coworker wrongdoing: A
qualitative analysis of observer attitudes in the decision to report versus not report
unethical behavior. 2000 Journal of Applied Communication Research, 28, 309-329.
28. Gilman AG, Rall TW, Nies AS, Taylor P. Goodman and Gilman's: The
pharmacological Basis of Therapeutics. 1996 New York: Pergamon Press.
29. Kolata G. New York Times News Service. "Who cares when our drugs fail?" (San
Diego Union-Tribune, Wed, Oct. 15, 1997: E-1,5.
30. Melmon KL, Morrelli HF, Hoffman BB, and Nierenberg DW. Melmon and
Morrelli's Clinical Pharmacology: Basic Principles in Therapeutics (3rd edition). New
York: McGraw-Hill, Inc., 1993.
31. Moore TJ, Psaty BM, Furberg CD. "Time to act on drug safety." JAMA, May 20,
1998, 279 (19):1571-3.
31a. Cullen DJ, Bates DW, Small SD, Cooper JB, Nemeskal AR, Leape LL. "The
incident reporting system does not detect adverse drug events: a problem for quality
improvement." Joint Commission Journal on Quality Improvement, Oct. 1995, 21
(10): 541-8.
32. Bates DW. "Drugs and adverse drug reactions: how worried should we be?
JAMA, Apr 15, 1998, 279 (15): 1216-7.
33. Dickinson JG. Dickinson's FDA Review. March 2000; 7 (3):13-14.
34. Cohen JS. Overdose: The Case Against the Drug Companies. 2001, Tarcher-
Putnum New York.
35. Stenson J. Few Residents Report Medical Errors, Survey Finds. Reuters Health.
Feb 21, 2003.
36. Henry J. Kaiser Family Foundation, Harvard School of Public Health.
Methodology: Fieldwork conducted by ICR - International Communications Research,
April 11-June 11, 2002.
37. Bond CA, Raehl CL, Franke T. Clinical pharmacy services, hospital pharmacy
staffing, and medication errors in United States hospitals. Pharmacotherapy. 2002
Feb;22(2):134-47.
38. Barker KN, Flynn EA, Pepper GA, Bates DW, Mikeal RL. Medication errors
observed in 36 health care facilities. Arch Intern Med. 2002 Sep 9;162(16):1897-903.